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Areas of Cover Guide This Guide Explains Which Locations Are Included in Each Area of Cover on the Aetna Pioneer, Aetna Summit and Aetna Maternity Plans

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Areas of Cover Guide This Guide Explains Which Locations Are Included in Each Area of Cover on the Aetna Pioneer, Aetna Summit and Aetna Maternity Plans Areas of cover guide This guide explains which locations are included in each area of cover on the Aetna Pioneer, Aetna Summit and Aetna Maternity plans. An area of cover is the geographic area of the world in which a member’s plan applies. The largest area of cover is Area 1 which includes all countries in Areas 2, 3, 4, 5, 6 and 7 plus the United States of America (US). The smallest area of cover is Area 7 which includes Africa only. A member’s area of cover must include their country of residence. Their area of cover should also include: • their home country if they need the option of returning home for treatment, and • any other country in which they may wish or need to receive treatment. Area 1 Includes all countries in Areas 2, 3, 4, 5, 6 and 7 plus the United States of America (US). Area 2 Includes the countries listed below and all countries in Areas 3, 4, 5, 6 and 7. American Samoa French Southern Territories Niue South Georgia and the South Antarctica Guam Norfolk Island Sandwich Islands Bouvet Island Heard Island and McDonald Northern Mariana Islands Tokelau British Indian Ocean Territory Islands Pitcairn Tonga Canada Hong Kong Russian Federation Tuvalu Christmas Island Kiribati Saint Helena, Ascension and United States Minor Outlying Cocos (Keeling) Islands Macau Tristan da Cunha Islands Cook Islands Marshall Islands Saint Pierre and Miquelon Vanuatu East Timor Micronesia, Federated States of Samoa Wallis and Futuna Fiji Nauru Solomon Islands French Polynesia New Caledonia Area 3 Includes China and all countries shown in Areas 4, 5, 6 and 7. Area 4 Includes the countries listed below and all countries in Areas 5, 6 and 7. Australia New Zealand Singapore Kuwait Qatar United Arab Emirates (UAE) Area 5 Includes the countries listed below and all countries in Areas 6 and 7. Åland Islands Brazil Faroe Islands Jamaica Albania Bulgaria Finland Kosovo Andorra Cayman Islands France Latvia Anguilla Channel Islands (Jersey, French Guiana Liechtenstein Antigua and Barbuda Guernsey, Alderney, Herm, Georgia Lithuania Argentina Jethou, Lihou and Sark) Germany Luxembourg Armenia Chile Gibraltar Macedonia Aruba Colombia Greece Malta Austria Costa Rica Greenland Martinique Azerbaijan Croatia Grenada Mexico Bahamas Curaçao Guadeloupe Moldova, Republic of Barbados Cyprus Guatemala Monaco Belarus Czech Republic Guyana Montenegro Belgium Denmark Haiti Montserrat Belize Dominica Honduras Netherlands Bermuda Dominican Republic Hungary Nicaragua Bolivia Ecuador Iceland Norway Bonaire, Sint Eustatius and El Salvador Ireland Panama Saba Estonia Isle of Man Paraguay Bosnia and Herzegovina Falkland Islands (Malvinas) Italy Peru Poland Saint Vincent and the Suriname United Kingdom Portugal Grenadines Svalbard and Jan Mayen Uruguay Puerto Rico San Marino Sweden Vatican City Romania Serbia Switzerland Venezuela Saint Barthélemy Sint Maarten Trinidad and Tobago Virgin Islands, British Saint Kitts and Nevis Slovakia Turkey Virgin Islands, U.S. Saint Lucia Slovenia Turks and Caicos Islands Saint Martin Spain Ukraine* Area 6 Includes the countries listed below and all countries in Area 7. Afghanistan Japan Myanmar South Korea Bahrain Jordan Nepal Sri Lanka Bangladesh Kazakhstan Oman Taiwan Bhutan Kyrgyzstan Pakistan Tajikistan Brunei Laos Palau Thailand Cambodia Lebanon Palestine, State of Turkmenistan India Malaysia Papua New Guinea Uzbekistan Indonesia Maldives Philippines Vietnam Iraq Mongolia Saudi Arabia Yemen Area 7 Africa: includes only the countries listed below. Algeria Djibouti Madagascar Senegal Angola Egypt Malawi Seychelles Benin Equatorial Guinea Mali Sierra Leone Botswana Eritrea Mauritania Somalia Burkina Faso Ethiopia Mauritius South Africa Burundi Gabon Mayotte South Sudan Cameroon Gambia Morocco Swaziland Cape Verde Ghana Mozambique Tanzania Central African Republic Guinea Namibia Togo Chad Guinea Bissau Niger Tunisia Comoros Kenya Nigeria Uganda Congo (DRC) Lesotho Réunion Western Sahara Congo-Brazzaville Liberia Rwanda Zambia Côte D’Ivoire Libya Sao Tome and Principe Zimbabwe We request all clients provide a disclosure or updated disclosure of any members or dependants located in sanctioned countries. Sanctioned countries include Crimea (Annexed Region of Ukraine), Cuba, Iran, North Korea, Sudan (North) and Syria*. If you and/or your dependants are working, residing or spending time in sanctioned countries or regions, please let us know immediately. * The above list is subject to change based on changes in financial sanctions regulations. In addition, there are other countries subject to less broad sanctions than the countries/region listed here. For more information, visit www.treasury.gov/resource-center/sanctions/Pages/default.aspx. We reserve the right to modify our products, services, rates and fees, in response to legislation, regulation or requests of government authorities resulting in material changes to plan benefits and to recoup any material fees, costs, assessments, or taxes due to changes in the law even if no benefit or plan changes are mandated. Please see the ‘Introduction’ section of this Handbook for more information about financial sanctions. Aetna® is a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties. Al Ain Ahlia and Aetna do not provide care or guarantee access to health services. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a health care professional. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Information is believed to be accurate as of the production date; however, it is subject to change. For more information, refer to www.AetnaInternational.com. If coverage provided by this policy violates or will violate any United States (US), United Nations (UN), European Union (EU) or other applicable economic or trade sanctions, the coverage is immediately considered invalid. For example, Al Ain Ahlia and Aetna companies cannot make payments or reimburse for health care or other claims or services if it violates a financial sanction regulation. This includes sanctions related to a blocked person or entity, or a country under sanction by the US, unless permitted under a valid written Office of Foreign Asset Control (OFAC) license. For more information on OFAC, visit www.treasury.gov/ resource-center/sanctions/Pages/default.aspx. Notice to United Kingdom residents: In the UK, Aetna Insurance Company Limited (FRN 458505) has issued and approved this communication. Notice to all: Please visit www.aetnainternational.com/ai/en/about-us/legal/regional-entities for more information, including a list of relevant entities permitted to carry on or administer insurance business in their respective jurisdictions. Important: This is a non-US insurance product that does not comply with the US Patient Protection and Affordable Care Act (PPACA). This product may not qualify as minimum essential coverage (MEC), and therefore may not satisfy the requirements, if applicable to you and your dependants, of the Individual Shared Responsibility Provision (individual mandate) of PPACA. Failure to maintain MEC can result in US tax exposure. You may wish to consult with your legal, tax or other professional advisor for further information. This is only applicable to certain eligible US taxpayers. ©2016 Aetna Inc. M021-66E-010116.
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